Measuring frailty: a comparison of the cumulative deficit model of frailty in survey and routine data
Year: 2025
Type: article
Abstract: ABSTRACT Purpose Frailty, a state of increased vulnerability to adverse health outcomes, impacts individuals and healthcare systems. The cumulative deficit model provides a flexible frailty measure but its application across diverse data remains underexplored. This study compares frailty indices derived from survey and routine data. Methods Frailty indices in the Clinical Practice Research Datalink (CPRD) Aurum (N = 1,625,677) and the English Longitudinal Study of Ageing (ELSA) (N = 5190) were compared for adults aged 65+ in England. Deficits were categorised as “one-to-one”, “one-to-many”, and “one-to-none”. Age-sex-standardised deficit prevalence, frailty distribution and associations with demographics were analysed using summary statistics and regression. Results Mean frailty index scores were similar (CPRD: 0.13 ± 0.10; ELSA: 0.13 ± 0.12) but differences were observed in the capture of specific deficits. The majority of deficits had a “one-to-none” or “one-to-many” mapping. Among 14 comparable deficits, visual impairment, fractures and heart failure were more common in CPRD, while falls, sleep disturbance and arthritis were more frequent in ELSA. Severe frailty and greater fitness were more prevalent in ELSA than CPRD. Sex and age influenced frailty similarly in both datasets, with frailty index scores increasing more rapidly with age in CPRD. Conclusion Differences in the number and types of deficits measured offset each other overall, supporting the cumulative deficit model’s premise that including a sufficient range of deficits does not significantly alter population-level frailty measures. This interchangeability may alleviate concerns about deficit selection, supporting more flexible approaches to population frailty assessment across both survey and routine data. STATEMENTS AND DECLARATIONS Competing Interests and Funding This research was funded by the Legal & General Group (research grant to establish the independent Advanced Care Research Centre at University of Edinburgh). The funder had no role in conduct of the study, interpretation or the decision to submit for publication. The views expressed are those of the authors and not necessarily those of Legal & General. The authors have no competing interests to declare that are relevant to the content of this article. Ethics approval (1) English Longitudinal Study of Ageing: our study used anonymised data from ELSA Wave 8, which is available to researchers via the UK Data Service via an institutional log in, and we adhered to the conditions of use. The ELSA study has ethical approval and participant consent as follows: “This study involves human participants and the English Longitudinal Study of Ageing (ELSA) Wave 8 received ethical approval from the South Central – Berkshire Research Ethics Committee on 23 September 2015 (15/SC/0526) ( https://www.elsa-project.ac.uk/ethical-approval ). Participants gave informed consent to participate in the study before taking part. (2) The study was approved by the Clinical Practice Research Datalink Independent Scientific Advisory Committee, protocol 23_002557. We adhered to the conditions of use and did not attempt to link between datasets. Preprint disclosure This article was previously published as a preprint on medRxiv (DOI: 10.1101/2025.01.24.25321086). KEY SUMMARY POINTS Aim We assess whether similar frailty prevalence is observed in survey and routine data despite differences in the number, types and prevalence of the individual deficits measured in frailty indices. Findings Frailty index calculations using established principles showed strong comparability between survey and routine data. Including a sufficient range of deficits does not significantly alter population-level frailty measures. Message The cumulative deficit model’s robustness to deficit selection supports flexible approaches to population frailty assessment across diverse data sources, such as survey and routine data.
Source: European Geriatric Medicine
Authors: Lara Johnson, Bruce Guthrie, Atul Anand, Alan Marshall, Sohan Seth
Institution: University of Edinburgh
Language: English
Topic: Frailty in Older Adults
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,390
OpenAlex ID: W4411729277